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Strategy 4.1

Improve understanding of the factors that affect access to service, quality and cost of services, and the means by which newly discovered effective mental health interventions are disseminated and implemented.

To meet this strategic objective, NIMH seeks new and innovative research that will rapidly inform and support the delivery of consistently high-quality mental health services to maximally benefit the greatest number of individuals with, or at risk for developing, a mental disorder. The present gap between optimal and typical mental health care can be reduced through discovery and analysis of key modifiable determinants of care quality, effectiveness, and cost. These determinants can then become targets of future individual-, system-, and policy-level interventions to optimize mental health care. NIMH encourages researchers to identify strategies for closing this gap that generalize beyond individual study samples.

Applicants should design their research studies to maximize the likelihood that their findings can and will be translated into practice—whether at the clinical, system, or policy level. At a minimum, this entails including in the proposed study design an examination of the service-delivery context(s), and analyses to yield practical knowledge for one or more stakeholder groups: patients and caregiver seeking evidence-based care; providers seeking to adopt proven strategies; systems administrators seeking to maximize quality and cost-effectiveness; and, policymakers aiming to improve public health while minimizing public cost burden. Such research should be conducted in real-world settings; involve the types of patients seen in routine practice, including those with medical and other co-morbidities; and, utilize care providers and technologies that can readily and widely be implemented in routine care settings.

In addition, NIMH encourages the development of new measures, study designs, and data analytic techniques for assessing the gap in healthcare access and for providing actionable information to a range of stakeholders for use in their decision making. New research methods for more precisely assessing public health impact are especially needed.

Research Priorities

  1. Understand the gap between optimal and typical care. Applicants should consider quantitative and qualitative measures and methods of value to diverse stakeholders and applicable to a broad range of service settings, populations, and financing arrangements.

    Priority areas include:

    1. Shedding light on the extent and nature of the gap between optimal mental health care and the typical mental health care that is currently delivered across the U.S.
    2. Determining how, if at all, the gap between optimal and typical care differs across disorders, intervention modes, care settings, types of providers, and populations, with a focus on identifying gap areas that can be closed rapidly
    3. Developing conceptual frameworks that underlie and explain the gap between optimal and typical care.
  2. Close the gap between optimal and typical care.

    Priority areas include:

    1. Policy
      1. Examining the effects of health care reform, including parity legislation, on accessibility, use, quality, outcomes and costs of evidence-based mental health care for vulnerable populations.
      2. Determining how cost-shifting and cost-sharing affect access to evidence-based mental health care and quality of care across settings.
      3. Determining the effects of Federal or State policies governing the prescription of psychotropic medications, or of prescription practices, on mental health outcomes and the quality and costs of pharmacotherapy.
    2. Economics and Financing
      1. Illustrating costs and cost-effectiveness of innovative preventive, treatment, and service system interventions.
      2. Uncovering the optimal use of pharmacoeconomics research results to inform health insurance coverage and reimbursement policies.
      3. Modeling the effects of various economic incentives on use, quality and costs of mental health care.
    3. Organization, Management, and Delivery of Services
      1. Identifying ways to distribute mental health services across service sectors that will produce the greatest synergy and best outcomes at reasonable cost.
      2. Conducting comparative effectiveness studies of systems-level service delivery interventions.
      3. Identifying core elements of effective systems interventions in specialty and non-specialty settings, including which components can and cannot be modified when interventions are delivered by different provider groups.
      4. Identifying or developing strategies for training providers of mental health services—including pre-service and ongoing in-service training—to efficiently and consistently deliver evidence-based mental health services across service sectors.
    4. Disparities In Mental Health Care
      1. Identifying, developing or testing service delivery systems that optimize the reach of mental health care to improve mental health outcomes for underserved populations.
      2. Identifying or developing models of mental health care that eliminate the disproportionate morbidity and mortality burden observed among individuals with serious mental illness.
      3. Developing valid, reliable indicators of mental health disparities of use to researchers and policymakers in assessing the impact of intervention and policy initiatives, along with strategies to prioritize, quantify, and track changes in these indicators over time.
    5. Community Integration and Re-entry
      1. Determining the most effective and cost-effective configuration of services to keep individuals with mental illness engaged in educational, employment, housing, social, and other roles in community life.
      2. Identifying, developing, or delivering mental health services that facilitate functioning for persons with mental illness upon re-entry into the community after relapse or institutionalization.
      3. Determining the effectiveness of widely implemented, but under-researched community mental health services.
    6. Technology
      1. Discovering, developing, or applying innovative technologies to expand access to services and enhance the way mental health services are delivered, assessed, and improved over time.
      2. Developing innovative technologies that improve mental health outcomes by augmenting or replacing traditional in-person care.
      3. Discovering, developing, or refining the use of novel technologies to capture, communicate, and apply patient-, organizational-, and systems-level information for enhancing mental health treatment, prevention, monitoring, and quality.
  3. Develop improved research methods.

    Priority areas include:

    1. Developing, testing, and moving into widespread use valid and actionable measures of the gap between optimal and typical care, quantified in terms that stakeholder groups find useful.
    2. Developing and testing valid and useful indicators of the individual, community, and societal value of mental health services.
    3. Developing, testing, and implementing parsimonious quality-of-care indicators at the individual, organizational, and system levels.
    4. Developing innovative sampling strategies, survey designs, and quasi- and non-experimental study designs that yield strong levels of inference regarding causality or mediation.

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